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In this prospective two-center feasibility study, we evaluate the diagnostic value of intraoperative ex vivo specimenPET/CT imaging of radical prostatectomy (RP) and lymphadenectomy specimens. Ten patients with high-risk prostate cancer underwent clinical prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) preoperatively on the day of surgery. Six patients received ⁶⁸Ga-PSMA-11 and four ¹⁸F-PSMA-1007. Radioactivity of the resected specimen was measured again using a novel specimenPET/CT device (AURA10; XEOS Medical, Gent, Belgium) developed for intraoperative margin assessment. All index lesions of staging multiparametric magnetic resonance imaging could be visualized. Overall, specimenPET/CT correlated well with conventional PET/CT regarding detection of suspicious tracer foci (Pearson coefficient 0.935). In addition, specimenPET/CT demonstrated all lymph node metastases detected on conventional PET/CT (n = 3), as well as three previously undetected lymph node metastases. Importantly, all positive or close (

Purpose Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy. Material and methods Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed. Results Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6–58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p p OR 9.74, 95% CI 2–46.2, p = 0.004; OR 4.01, 95% CI 1.36–11.82, p = 0.013). Conclusion The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.

Les douze textes qui composent ce volume sont issus du colloque international La Locution organisé par l’École Normale Supérieure de Fontenay/Saint-Cloud en novembre 1994. On assiste aujourd’hui à une extension de la notion de locution, qui, traditionnellement limitée aux lexies complexes et aux proverbes, tend à intégrer aussi bien les structures textuelles que la détermination de certaines expressions par des conditions d’énonciation. Le foisonnement terminologique reflète la multiplicité des types d’objets concernés. Face à l’insuffisance de certaines théories linguistiques dans ce domaine, ce sont la dimension pragmatique des usages et leur inscription mémorielle qui sont mises en avant. Tandis que l’étude des locutions en langue se poursuit sur des bases critiques, les différents modes sous lesquels le locutionnel a affaire avec le discours sont de nouveaux champs d’investigation. Le défigement est un terrain d’études privilégié pour les conditions de l’interprétation sémantique des discours. Ces renouvellements permettent de concevoir de nouveaux dictionnaires donnant une image plus complète de tout ce qui, dans les usages, tend à figer le discours.

Cerenkov luminescence imaging (CLI) was successfully implemented in the intraoperative context as a form of radioguided cancer surgery, showing promise in the detection of surgical margins during robot-assisted radical prostatectomy. The present study was designed to provide a quantitative description of the occupational radiation exposure of surgery and histopathology personnel from CLI-guided robot-assisted radical prostatectomy after the injection of 68Ga-PSMA-11 in a single-injection PET/CT CLI protocol. Methods: Ten patients with preoperative 68Ga-PSMA-11 administration and intraoperative CLI were included. Patient dose rate was measured before PET/CT (n = 10) and after PET/CT (n = 5) at a 1-m distance for 4 patient regions (head [A], right side [B], left side [C], and feet [D]). Electronic personal dosimetry (EPD) was used for intraoperative occupational exposure (n = 10). Measurements included the first surgical assistant and scrub nurse at the operating table and the CLI imager/surgeon at the robotic console and encompassed the whole duration of surgery and CLI image acquisition. An estimation of the exposure of histopathology personnel was performed by measuring prostate specimens (n = 8) with a germanium detector. Results: The measured dose rate value before PET/CT was 5.3 ± 0.9 (average ± SD) μSv/h. This value corresponds to a patient-specific dose rate constant for positions B and C of 0.047 μSv/h⋅MBq. The average dose rate value after PET/CT was 1.04 ± 1.00 μSv/h. The patient-specific dose rate constant values corresponding to regions A to D were 0.011, 0.026, 0.024, and 0.003 μSv/h⋅MBq, respectively. EPD readings revealed average personal equivalent doses of 9.0 ± 7.1, 3.3 ± 3.9, and 0.7 ± 0.7 μSv for the first surgical assistant, scrub nurse, and CLI imager/surgeon, respectively. The median germanium detector-measured activity of the prostate specimen was 2.96 kBq (interquartile range, 2.23-7.65 kBq). Conclusion: Single-injection 68Ga-PSMA-11 PET/CT CLI procedures are associated with a reasonable occupational exposure level, if kept under 110 procedures per year. Excised prostate specimen radionuclide content was below the exemption level for 68Ga. Dose rate-based calculations provide a robust estimation for EPD measurements.

Simple Summary Advanced urothelial bladder cancer (BC) shows a heterogeneous response to both platinum and immune checkpoint inhibitor (ICI) therapies. The PD-1/PD-L1 signaling pathway represents an immune escape mechanism and tissue PD-L1 expression was shown to be associated with patients’ prognosis and therapy response in various solid tumors. In the present study, we found for the first time that higher pretreatment serum PD-L1 levels are associated with shorter survival in platinum- and ICI-treated BC patients. Abstract Serum PD-L1 (sPD-L1) levels are associated with prognosis in various tumors but has not yet been investigated in advanced bladder cancer. We assessed pretreatment serum samples from 83 BC patients who received platinum chemotherapy and from 12 patients who underwent immune checkpoint inhibitor (ICI) therapy. In addition, on-treatment samples from further therapy cycles were collected during chemotherapy (n = 58) and ICI therapy (n = 11). Serum PD-L1 levels were determined using ELISA. High baseline sPD-L1 levels were associated with worse ECOG status (p = 0.007) and shorter overall survival for both chemotherapy- and ICI-treated patients (p = 0.002 and p = 0.040, respectively). Multivariate analysis revealed high baseline sPD-L1 level as an independent predictor of poor survival for platinum-treated patients (p = 0.002). A correlation analysis between serum concentrations of PD-L1 and matrix metalloprotease-7 (MMP-7)—a protease which was recently found to cleave PD-L1—revealed a positive correlation (p = 0.001). No significant sPD-L1 changes were detected during chemotherapy, while in contrast we found a strong, 25-fold increase in sPD-L1 levels during atezolizumab treatment. In conclusion, our work demonstrates that pretreatment sPD-L1 levels are associated with a poor prognosis of BC patients undergoing platinum and ICI therapy. Future research should prospectively address the value of sPD-L1 in predicting treatment response.

CA Krafft Introduction: To evaluate efficacy and safety of Botulinum Toxin A (Botox) injection in the detrusor for day-time lower urinary tract conditions with mainly overactive symptoms, we analyzed our uropediatric Botox-treated collective. Materials and Methods: 21 Children who received a Botox treatment in our hospital between 2016 and 2020 for refractory day-time lower urinary tract conditions with mainly overactive symptoms with conclusive follow up were analyzed. In all cases we applicated 100 IU Botox. Results: Mean age of patients was 9,19 (±3,0). In 8/21 cases a preoperative urodynamic assessment was available. We reached a median follow up of 289 days (range 34-750). Mean bladder capacity increased from 157 ml (±18.4) to 213 ml (±24.5) (p = 0.001). Mean voiding frequency decreased from 7.4 (±0.61) to 6.2 (±0.55) (p = 0.015). 13/21 Patients (61.9%) encountered a partial or complete therapy response while 8/21 Children (38.1%) showed a therapy failure. Within the responder group, 8/13 Children (61, 5%) experienced an ongoing response. However, 5 Children relapsed on average in 176 days (±45, 5). 3 Children received a repeated injection of Botox. We observed no serious side effects. Discussion/Conclusion: Even though pediatric Botox therapy still lacks standardization; our study indicates a safe and effective use for day-time lower urinary tract conditions with mainly overactive symptoms in children who are resistant to common treatments. Moreover, we found a one-time injection in most cases to be sufficient to improve symptoms in the long term.